Betrayal & Beyond Questionnaire

Betrayal & Beyond QuestionnaireMitchell2026-02-04T13:42:53-08:00

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email(Required)

Phone(Required)

Church Affiliation(Required)

Marital Status(Required)

Spouse's Name(Required)

Name and Ages of Children (if applicable)

Names of friends or family who attend Betrayal & Beyond (if applicable):

Please select the following issues/feelings that you are currently or have been struggling with:(Required)

Depression

Anxiety / fear

Anger

Guilt / shame

Low self-esteem / lack of confidence

Perfectionism or obsessive behavior

Substance abuse (alcohol, drugs, etc.)

Eating disorder or weight problems (anorexia, bulimia, binge eating, overeating)

Addictions (other than those listed above, i.e., gambling, smoking, sex, work)

Problems obtaining or keeping a job

Relationship problems (marriage, dating, family, friends)

Spousal abuse / violence

Of those you checked, which two are the most pressing concerns?(Required)

When you get angry with God, what is it usually about?(Required)

Rate your Christian walk on a scale of 1 to 10:(Required)

1	2	3	4	5	6	7	8	9	10

What area of your spiritual life causes you to sin or stumble the most?(Required)

What do you hope to gain from this class?(Required)

Do you have additional questions or things you feel are important that we know up front?

(425) 355-9330

6830 Highland Dr
Everett, WA 98203

New Life Church
6830 Highland Dr
Everett, WA 98203